Special ArticleLaparoscopic Vessel Sealing Technologies
Section snippets
Advanced Bipolar Devices
In reality, all electrosurgery is “bipolar” inasmuch as there needs to be 1 electrode from which the electrical current enters tissues and another electrode through which the current leaves the patient and returns to the electrosurgical unit (ESU) 1, 3. By convention, monopolar electrosurgery refers to the arrangement of a single small electrode contained within the surgical instrument that delivers focused alternating electrical current to the target tissue to impart the desired surgical
Ultrasonic Devices
Not dissimilar in appearance to new-generation bipolar electrosurgical devices, ultrasonic laparoscopic energy sources are also able to seal vessels and transect tissues. Indeed, most of the tissue effects produced by ultrasonic devices are the same as those for bipolar devices (Table 2). However, these tissue effects are produced without the passage of electrical current through the patient or target tissue. Ultrasonic devices instead convert electrical energy to both mechanical and thermal
Comparison of Advanced Bipolar and Ultrasonic Vessel Sealing Technologies
The reasons for a surgeon’s preference for a particular laparoscopic energy source may be many and varied. A common reason for choosing a particular instrument is the surgeon’s own experience with that instrument that may have been preordained by a mentor during surgical training. Unfamiliar technologies often are not trialed. Surgeons are also subjected to marketing strategies and even inducements. Indeed, device manufacturers sponsor many of the studies on energy sources published in the
Conclusions
The development of laparoscopic vessel sealing devices has revolutionized modern laparoscopy. Despite these advances, the reliance on monopolar electrosurgery persists because of its wider range of tissue effects and dissection capabilities. At present, there is no clear evidence to support the use of either advanced bipolar or ultrasonic devices in preference to the other, although each technology has well-characterized advantages and disadvantages. It is likely that the surgeon will rely on 2
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Cited by (58)
Is an Ultrasonic and Bipolar Integrated Energy Device More Useful Than a Conventional Electric Device in Head and Neck Free Flap Reconstruction? A Prospective Comparison
2020, Journal of Oral and Maxillofacial SurgeryImproved hemostasis with plasma kinetic bipolar sealing device in the vaginal steps of laparoscopic-assisted vaginal hysterectomy
2019, Taiwanese Journal of Obstetrics and GynecologyA comparison of short-term outcomes of neck dissection for head and neck cancers using Thunderbeat™, LigaSure™ or treatment without an energy-based device: A case controlled study
2018, International Journal of SurgeryCitation Excerpt :Several studies have demonstrated that operative time and intraoperative blood loss are related to clinical outcomes and complications in head and neck surgery [6–8]. Over the last two decades, various energy-based devices (EBDs) have been developed to achieve surgical hemostasis [9,10]. EBDs enable operative time to be reduced through sutureless vessel ligation without increasing postoperative complications [11,12].
Understanding and Practising Safe Electrosurgery in the Operating Room
2018, Journal of Obstetrics and Gynaecology CanadaRisk management for surgical energy-driven devices used in the operating room
2018, Journal of Visceral SurgeryCitation Excerpt :Poor visualization of the tip of instruments during their trajectory and thermal diffusion are possible explanations for the origin of these complications. To avoid them during use of monopolar or bipolar electrocoagulation, it is recommended to use the lowest intensity of current possible, and to concentrate the electrocoagulation on a small surface while limiting the time of electrocoagulation and avoiding carbonization as much as possible [3,8,9]. Other recommendations such as avoiding any contact between activated monopolar instruments and other devices and privileging the use of trocars that are entirely metallic or plastic are solutions to avoid the risk of visceral burns.
Advanced bipolar vessel sealing devices vs conventional bipolar energy in minimally invasive hysterectomy: a systematic review and meta-analysis
2024, Archives of Gynecology and Obstetrics
The authors declare that they have no conflict of interest.